Table 1 Advantages and disadvantages of echocardiography and cardiovascular magnetic resonance in assessment of valvular heart disease
Modality | Advantages | Disadvantages |
|---|---|---|
Transthoracic echocardiography (TTE) | Widely available [6] Inexpensive [5] Safe [4] | Limited accuracy in patients with large body habitus and chronic obstructive pulmonary disease [7] Limited accuracy in the presence of eccentric/multiple regurgitant jets [9] Suboptimal assessment of right heart [8] |
Transoesophageal echocardiography | Not limited by body habitus [44] Superior image quality when TTE is suboptimal [1] Visualisation of structures not assessed by TTE e.g. left atrial appendage [1] | Moderately invasive. Risk of bleeding and oesophageal perforation [44] Requires presence of trained medical personnel [44] Potential complications of sedation [44] Reduced utility during pandemic due to high aerosol production [45] |
Standard CMR (LV/RV cine stack, PCMR and LGE) | Reference-standard left and right ventricular size and function assessment [14, 15] Accurate indirect quantification of atrio-ventricular valve regurgitation, even in the presence of eccentric and multiple jets [39] Tissue phenotyping/quantification of fibrosis [46] | Inaccurate direct quantification of atrio-ventricular valvular regurgitation [13] Potential for error in stroke volume calculation [6] |
4D flow CMR | Regurgitant jet visualisation [22] Direct regurgitant jet quantification [9] No geometric assumptions [22] Simultaneous analysis of flow across all four valves [25] Accurate peak velocity assessment vs. PCMR [31] May be advantageous in combined valve lesions [22] Measurement of fluid biomechanics [29] Simple acquisition [29] Free-breathing [23] Plane reformatting is possible [25] | Time-consuming post-processing [29] Limited temporal and spatial resolution [29] Limited software availability [16] |